
Cases of prostate cancer are projected to double from 1.4 million per yr in 2020 to 2.9 million per yr by 2040, with low- and middle-income countries (LMICs) predicted to see the very best increases in cases, based on The Lancet Commission on prostate cancer which shall be launched by a presentation on the European Association of Urology Congress.
The variety of annual prostate cancer deaths worldwide is predicted to rise by 85% over the 20-year period, from 375,000 deaths in 2020 to almost 700,000 deaths by 2040. The true numbers will likely be much higher than the recorded figures on account of under-diagnosis and missed opportunities for data collection in LMICs.
Most of those deaths are expected to be in LMICs, on account of the rising variety of cases and increasing mortality rates in these countries. Deaths from prostate cancer have declined in most high-income countries (HICs) for the reason that mid-Nineties.
Prostate cancer is already a significant explanation for death and disability, accounting for 15% of all male cancers. It’s the second most typical explanation for cancer deaths in UK men and essentially the most common type of male cancer in greater than half of the world’s countries.
Aging populations and increasing life expectancy will result in higher numbers of older men in coming years. Because the foremost risk aspects for prostate cancer – equivalent to being aged 50 or older and having a family history of the disease – are unavoidable, it can not be possible to forestall the upcoming surge in cases through lifestyle changes or public health interventions.
Professor Nick James, lead creator of the Commission, Professor of Prostate and Bladder Cancer Research at The Institute of Cancer Research, London, and Consultant Clinical Oncologist at The Royal Marsden NHS Foundation Trust, said: “As increasingly men around the globe live to middle and old age, there shall be an inevitable rise within the variety of prostate cancer cases. We all know this surge in cases is coming, so we’d like to start out planning and take motion now. Evidence-based interventions, equivalent to improved early detection and teaching programs, will help to avoid wasting lives and forestall in poor health health from prostate cancer within the years to come back. This is very true for low- and middle-income countries which can bear the overwhelming brunt of future cases.”
Global need for brand spanking new and improved early detection programs
In HICs, screening for prostate cancer often involves the PSA test, a blood test that measures levels of a protein called prostate-specific antigen (PSA). Nonetheless, PSA tests often detect prostate cancer which can never cause symptoms and wishes no treatment. The present approach to prostate cancer diagnosis within the UK and plenty of other HICs relies on ‘informed selection’ PSA testing – when men aged 50 or over with no disease symptoms can request a PSA test from their doctor after a discussion of the risks and advantages. The Commission argues there’s evidence to suggest this approach results in over-testing in low-risk older men but doesn’t increase detection of prostate cancer in younger men at higher risk. The authors also highlight huge variations within the likelihood of men being diagnosed with advanced prostate cancer with the ‘informed selection’ PSA testing strategy, for instance The National Prostate Cancer Audit within the UK found that in 2022, 1 in 8 men (12.5%) with prostate cancer are diagnosed with advanced prostate cancer in London, whereas in Scotland greater than 1 in 3 (35%) were diagnosed late.
As an alternative, the authors recommend using MRI scans together with PSA testing to screen men at high risk of prostate cancer in HICs, equivalent to those with a family history of the disease, those of African origin and people carrying the BRACA2 mutation. They argue that this approach would each reduce over-diagnosis and over-treatment, while detecting potentially lethal disease. MRI is effective in imaging cancers and will be used to supply information as as to if the disease is aggressive and more likely to be life-threatening. Nonetheless, biopsies are simpler at identifying aggressive cancers, so MRI alone mustn’t be used to research men at high risk of disease.
The effectiveness of population-level PSA testing has not been tested in LMICs and there’s an urgent need for cancer screening trials in these countries. Latest approaches to enable earlier diagnosis in LMICs are vital, as most men in these countries present with metastatic cancer – a complicated type of disease where the cancer has spread to other parts of the body, often the bones. Men with late-stage prostate cancer are much less more likely to survive for a protracted time period than those that are diagnosed early.
“With prostate cancer we cannot wait for people to feel in poor health and seek help – we must encourage testing in those that feel well but who’ve a high risk of the disease with a purpose to catch lethal prostate cancer early. Pop-up clinics and mobile testing offer cost-effective solutions that mix health checks and education. Within the UK we recently trialled a brand new revolutionary outreach programme called The Man Van which provided free health checks – including PSA tests – to high-risk men in London aged 45 and over. By bringing a van with quick and straightforward testing straight to men at work and in the neighborhood, and targeting those that have the next risk of prostate cancer, we provided hundreds of health checks which resulted in almost 100 cancer diagnoses in men who might otherwise have only seen a physician once their cancer has progressed to a more advanced stage. The combination of education, outreach, testing and referral utilized in The Man Van trial can also achieve success in LMICs and we hope to see similar initiatives rolled out globally to enhance early detection of prostate cancer,” said Professor Nick James (also project lead for the ‘Man Van’).
In addition to being a significant growing challenge, prostate cancer can also be an indicator of a wider must tailor future healthcare to address increases in several diseases, because the numbers of men reaching middle and old age increase worldwide. The Commission calls for trials of prostate cancer screening in LMICs to form a part of holistic approaches with a broader deal with men’s health.
Raising awareness of advanced prostate cancer and available therapies
There’s a necessity to boost awareness of the hazards and symptoms of metastatic prostate cancer amongst men and their families in LMICs. Public awareness of the important thing features of advanced prostate cancer – equivalent to bone pain, brought on by metastatic disease – is poor in lots of LMICs. Similarly, there is usually low public awareness that treatments can delay survival and reduce suffering – including low cost, effective ones equivalent to hormone therapy – can be found in lots of LMICs. As with early diagnostic capability, there’s a must scale-up availability and improve access to treatments for advanced disease in LMICs.
Improving education concerning the disease is critical, and the Commission authors suggest that programs should involve recent technologies and channels equivalent to smartphones, social media, and influencers. They highlight Project PINK BLUE, a corporation that delivers a spread of programs to boost awareness of breast, cervical, and prostate cancer in Nigeria, and provides free cancer screening. A lot of Project PINK BLUE’s programs utilize digital technologies and involve well-known public figures and celebrities.
Professor James N’Dow, Chair in Surgery, University of Aberdeen and Founding father of Horizons Trust & Horizons Clinic, Gambia, said: “The difficulty in low- and middle-income countries is that late diagnosis of prostate cancer is the norm. Improved outreach programs are needed to higher inform people of the important thing signs to look out for and what to do next. Implementing these in tandem with investments in cost-effective early diagnostic systems shall be key to stopping deaths from prostate cancer as cases inevitably rise with a worldwide aging population.”
He continues, “In addition to the apparent direct effects on individual men’s health, rising numbers of cases and deaths from prostate cancer could have huge economic and social impacts on families in LMICs. Men in these countries are fairly often a family’s foremost breadwinner, so in the event that they die or turn into seriously in poor health, this will result in families facing major economic hardship. By preparing now for the upcoming surge in prostate cancer cases, with a selected emphasis on improved education and earlier diagnosis programs, lots of these harms may very well be reduced substantially.”
Constructing capability to diagnose and treat prostate cancer early in LMICs
Optimal management of prostate cancer requires the supply of specialist staff and infrastructure to support diagnosis, surgery and radiotherapy to treat localized prostate cancer, and radiotherapy and hormone therapy for metastatic disease.
A significant barrier to improved prostate cancer care in LMICs is a scarcity of trained staff and specialist facilities. These shortages usually are not limited to prostate cancer, and the 2015 Lancet Commission on Surgery found that 9 out of 10 people in LMICs cannot access basic surgical care. [4]
Expanding early diagnostic capabilities in LMICs will increase the rates of detection of early-stage prostate cancer, further increasing demand for surgery and radiotherapy. Urgent measures are subsequently needed to construct surgical and radiotherapy capability in these countries. The Commission authors state that establishing regional hubs could provide the infrastructure needed to extend specialist training and improve patient access to radiotherapy and surgery.
For men with metastatic disease, earlier diagnosis and starting hormone therapy earlier will reduce deaths and forestall serious complications like painful spinal cord compression and urinary retention, which may result in infection and kidney damage.
More research is required on ethnic inequities in care and survival
The Commission authors highlight the necessity for more research to higher understand prostate cancer in men who usually are not of White European origin, to enable improved detection and care in these groups. Research and knowledge of prostate cancer is heavily focussed on White European men, and most studies have been done in HICs. Nonetheless, Black men, especially those of West African descent, have the next risk of developing prostate cancer than White or Asian men, though the explanations for this are unclear. There’s also the next death rate from prostate cancer amongst Black men, nevertheless it is just not known if that is driven by the differences in case rates or by other aspects equivalent to differing disease biology or societal aspects equivalent to deprivation or racism. More data is required to discover the driving aspects behind these trends.
The Commission authors call for mandatory recording of ethnicity in clinical trials, and that trials should reflect the ethnic mixture of the populations being studied to be sure that the findings apply to all groups. The Commission authors also call for trials examining prostate cancer screening, early diagnosis, and treatment in LMICs.
Source:
Journal reference:
James, N. D., et al. (2024) The Lancet Commission on prostate cancer: planning for the surge in cases. The Lancet. doi.org/10.1016/S0140-6736(24)00651-2.